Monday, July 25, 2016

Training on Empty: Chapter 16 (Possible TW)

Possible trigger warning with mention of behaviors and numbers.

Chapter 16 – Males and Eating Disorders

“My theory is that men are no more liberated than women.” – Indira Gandhi

It's rare to think of a man when the topic of eating disorders comes up, but women are not the only ones who suffer. It’s much more common for men to confess to binge-eating than to any other eating disorder, but that doesn't mean that they are immune to other eating issues. Over thirty percent of binge-eaters are male. Eating disorders in general are starting to be more recognized in men, especially gay men, who make up the majority of males with eating disorders at this point or are at least more willing to admit to having one. Many gay men already worry about prejudice and discrimination as a result of their sexual orientation, and added to this burden is the fear that their peers will judge them in terms of their weight. The term “gay fat” emerged to describe a gay man who could be seen as normal in size by most, but fat in the eyes of other gay men. Within the gay culture, there is so much pressure to be perfectly toned and lean that many men are developing an abnormal focus on their bodies and falling into disordered eating patterns. Though gay men are more likely to seek treatment than men in general, they are also developing eating disorders and body dysmorphic disorder – a condition in which people become preoccupied or obsessed with a perceived flaw in their appearance – at an alarming rate. Even though gay men are more often diagnosed with eating issues, they are not the only ones affected.

Many people agree that anorexia in men may be under-diagnosed, and there are several reasons for this. Often, physicians will not recognize the illness in a man owing simply to the false assumption that anorexia is a women’s disease. According to the article “Eating Disorders in Men” by Margarita Tartakovsky, M.S., most of the diagnostic criteria for anorexia focus on women. Typically, doctors look for amenorrhea and a fear of fatness. However, men’s symptoms can differ greatly from those of women. For example, while most women report a fear of getting fat or feeling fat, men might express the desire to be more muscular and still suffer from the disorder. Just as there is societal pressure for women to conform to a certain body type, the pressure on men to look a certain way is becoming more apparent as well. Lately, there has been an increase in men seeking plastic surgery such as pectoral implants, calf implants and liposuction. More often than not, men keep quiet about their struggles with food, which leads others to assume that there isn’t a real problem or the problem is not severe. Obsessive exercise is common in men who suffer from anorexia. Because there are sports in which low body weight is acceptable, men who engage in these sports can rationalize that their low body weight is not an issue.

Dave Dunham, a renowned road, mountain and snowshoe racer and a recovered anorexic, admits that it’s often harder for men to open up about eating disorders. He says that “there is a societal expectation for men to be tougher and not really talk about problems.”

Dave’s issues began after college, when his weekly mileage was increasing and his weight was decreasing. While some people exercise in order to work off calories already consumed, Dave exercised in order to give himself permission to eat. “I started running triples – three runs a day,” he says. “I think this is when things really started to snowball. I didn't like running within a few hours of eating, so it became difficult to find a time to eat. Somewhere along the line, instead of eating to run, I was running to allow myself to eat. If I didn't run long enough or hard enough, I felt I didn't deserve to eat. Eventually, I got to the point where I was not eating, except for dinner. This kept the illusion that nothing was wrong. My doctor had been encouraging me to get help for a couple of years, but I kept saying that despite knowing I had a problem, I wasn't ready to do anything about it. At 5’7”, I was down to 115 pounds and injured when I finally decided that it was time to get help. I bottomed out weighing less than 110 pounds and finally got into an eating disorder program.” Fortunately, Dave has recovered from his illness. He no longer uses his training to feel okay about eating. To anyone struggling with an eating disorder, especially anorexia, Dave recommends throwing out the scale and eating a variety of foods.

Though reluctant to admit it, men also suffer from bulimia. When I was a young runner, I met a top mountain runner who told me years later that while he was racing and training, he had bulimia. He would not go into detail about his illness or how he eventually overcame it, but he did say that the pressure of running, racing and wanting to be thin contributed to the purging cycle.

Kevin Beck, a running coach and former sub-elite marathon runner, developed bulimia during his freshman year in college. He believed that there was such a stigma for men to admit having an eating disorder that he kept it a secret for years, though he says that he feels that he would have studiously guarded his secret even had he been female. It wasn’t until he was much older that he was able to finally confess that he had a problem despite sensing those around him, especially his mother, suspected that he had issues.

Kevin admits that the illness isolated him, chiefly in a psycho-emotional sense but sometimes literally. His social life was compromised during periods of extreme binging and purging, as for all intents and purposes he was in the throes of an addictive drug at such times. For him, bulimia became a way to cope. It was an easy “solution” to always fall back on when something seemed difficult or he got overwhelmed with emotion, good or bad.

Kevin cautions anyone struggling to talk about it with someone. Even just admitting out loud that he had a problem seemed to help. It took the power out of the illness to some extent. “I wish I had said something. It’s so shame-based,” he says. “I wish guys would be able to talk about how they feel and express when they feel isolated and emotionally burdened. It would help dissolve internal conflict.”

As far as actual symptoms, it has been reported that men and women suffer similar rates of accompanying unhappiness, anxiety, depression, self-injury and substance abuse. In addition to the bulimia, Kevin has also struggled with alcohol abuse. In general, co-existing addictions are more common in bulimics than in anorexics. Kevin attributes this to bulimics having poor impulse control, while anorexics tend to exert too much control. Samuel S. Lample, in his article “Eating Disorders: Not just a women’s problem,” reports that a study of 135 male eating-disorder patients revealed that across all diagnoses, 37% had a comorbid substance use problem, with alcohol abuse the most common problem (seen at a rate roughly three times that of cocaine abuse.) More specifically, Lample notes, 61% of patients with bulimia had a co-occurring substance abuse problem, and that they were three times more likely to have this problem than anorexic men.

In the same article, Lample suggests that those with bulimia show decreased prefrontal cortex brain activity but increased activity in the limbic system. This combination potentially leads to poor judgment and possible emotional problems. Writes Lample: “The strong food cravings common in those who binge eat, are linked to the brain's hedonic system, which regulates risk-taking and novelty-seeking behaviors, self-control, and pain avoidance. In short, bingeing behaviors can be seen as resulting from problems in the hedonic system around impulse control.”

Despite the hope that he would one day simply outgrow the illness, Kevin still struggles with it today. Bulimia has taken its toll on him both emotionally and physically. The continual throwing up throughout the years has caused his teeth to erode, and a computerized tomography (CT) scan has shown that his brain, almost certainly as a result of alcohol, resembles that of a much older person. Kevin feels that without getting to the root of his problems, he won’t be able to find better ways to cope. He can go years without binging and purging or years without drinking, only to relapse. Because Kevin understands the illness so well, he has, despite not being able to help himself, been able to offer help to others. He feels that early detection is the key to a less traumatic and more complete recovery.